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_Title:_ The Montreal Medical Gazette, Volume 1, Issue 3 June 1844
_Date of first publication:_ 1844
_Author:_ William Sutherland (1815-1875), Francis Badgley (1807-1863)
(Editors)
_Date first posted:_ Sep. 20, 2014
_Date last updated:_ Sep. 20, 2014
Faded Page eBook #20140924
This ebook was produced by: Marcia Brooks, Paulina Chin & the online
Distributed Proofreaders Canada team at http://www.pgdpcanada.net
THE
MONTREAL MEDICAL GAZETTE,
BEING A
MONTHLY JOURNAL OF MEDICINE,
AND
THE COLLATERAL SCIENCES.
Edited by Francis Badgley, M. D., and William Sutherland, M. D.
Vol. I. MONTREAL, JUNE 1, 1844. No. 3.
* * * * *
DR. H. NELSON ON INGUINAL HERNIA.
AUX EDITEURS DE LA GAZETTE MEDICALE DE MONTREAL.
Messieurs,—Le 30 Mars, à 5 P. M. je fus appelé auprès de Hypolite
Laroche, du Fauxbourg de Québec, âgé de 42 ans, homme fort et vigoureux,
souffrant “d’un horrible mal de ventre avec de coliques, ne pouvant
aller à la selle, et vomissement depuis le midi.” D’après cette
description “explicite,” je soupçonnai l’existence d’une hernie
étranglée—en effet, je le trouvai, souffrant sous tous les symptômes
les plus violens de l’étranglement intestinal. Le scrotum était de la
grosseur d’une vessie soufflée. Je déterminai immédiatement de réduire
la tumeur herniaire, par le moyen ordinaire, le taxis, que j’employai de
mon mieux, plaçant une main à l’ouverture inguinale externe, pour
repousser l’intestin par degrés, tandisque de l’autre, je supportai le
scrotum et forçai son contenu sur l’anneau. Je continuai cette
manipulation que très peu de temps, le malade se plaignant tellement, et
repoussant mes efforts, qu’il me sembla y avoir du danger d’augmenter
l’étranglement par une plus considérable descente de l’intestin, ou de
produire une inflammation qui pourrait avoir des suites funestes.
J’ordonnai que la tumeur fut supportée et élevée par des linges au
périnée, afin qu’il n’y eut pas d’irritation sur la partie étranglée par
le poids de la tumeur aussi bien que par sa position dépendante qui
invitait un suintement continuel des fluides intestinaux, et qui fait
toujours une considérable partie du contenu d’un sac herniaire. Je fis
couvrir de neige toute la tumeur, aussi bien que la région inguinale—je
lui donnai du _Sulfate de Morphine_, et _extrait de Belladonne_ de
chaque un demi grain—ce qui en quelques temps fit disparaître les
douleurs et les coliques; de sorte que le malade s’assoupit, et en peu
de temps dormait d’un sommeil profond. Vers une heure après, il fut
éveillé, par une légère douleur, suivie de gargouillement dans le
scrotum, qui se trouva dans un instant débarrassée de son contenu—la
hernie n’existait plus.
La méthode employée dans ce cas, est celle adoptée par mon père, depuis
plusieurs années, et avec beaucoup de succès.
Il est du devoir du Médecin, dans tous les cas de hernie, de s’employer
à réduire la tumeur par le taxis, le plutôt possible; mais si elle est
grosse et très sensible, résistant à des efforts modérés, il doit
discontinuer la manipulation, car autrement il produirait un tel degré
d’inflammation dans l’intestin, qu’il pourrait en résulter la mort du
malade; soit qu’on ne parvienne pas à faire la réduction, ou soit qu’on
y réussisse par trop de violence, puisque tous les cas terminant
fatalement sont attribués à l’inflammation. Il est vrai aussi que se
laissant conduire par trop de prudence, on peut quelques fois faillir
d’opérer la réduction par la manipulation,—mais en même temps on se
garde de la plus funeste de toutes les suites de telles lésions,
l’inflammation; et comme dans le cas sous observation, n’ayant pas été
porté bien loin, les remèdes et les applications furent suivies du plus
heureux effet.
J’expliquerai l’opération de mes remèdes comme suit: la position élevée
d’abord, facilite le retour du fluide au travers l’anneau, le froid
produit une diminution de sang dans les vaisseaux, en même temps
cessation de la douleur, et la condensation du gaz ou des vents, qui,
avec les fluides, forme le volume de la hernie—une action péristaltique
dans la portion inférieure de l’intestin le retire dans l’abdomen, et
voilà comme il me semble qu’il regagne sa place originaire, ce qui se
fait sentir par une légère douleur et gargouillement. Quelques remarques
que l’on puisse faire sur cette théorie, je puis recommander et soutenir
le succès du traitement employé dans d’autres cas que le présent. Mon
anodin à l’effet de calmer l’irritation et l’excitement du système,
principalement des intestins—d’empêcher les vomissemens, de produire le
sommeil, et le relâchement du canal inguinal.
Vous souhaitant tout le succès que votre journal mérite,
J’ai l’honneur d’être,
Messieurs,
Votre Serviteur Obédt.
Horace Nelson, M. D.
Montréal, 15 Mai, 1844.
DR. VON IFFLAND ON INJURIES OF THE HEAD.
TO THE EDITORS OF THE MONTREAL MEDICAL GAZETTE.
Gentlemen,—The notes of the _post mortem examination_ of the cases,
contained in the enclosed sheets, having been taken on paper detached
from that descriptive of them, I cannot, after the most diligent search,
trace their place of _safe deposit_; but as the skulls are in the
possession of Dr. James Douglas, I have this day directed his attention
to the subject, and I have every reason to believe that he will seize
the earliest opportunity of placing at your disposal an accurate exposé
of the bones found fractured in their bases.
Should, however, the desired information not be received in time for
subjoining it to the cases, and for appearance, _in whole_, in the June
number of the _Gazette_, the conclusion may be deferred to the
succeeding one,—long before the publication of which, it is more than
probable, that Dr. D. will also put me in possession of such additional
observations, as may form the subject of another article.
Our communications through the mail in this section, are not, I may add,
very favourable to despatch.
I have the honour to be, Gentlemen,
Truly, your devoted and faithful servant,
A. Von Iffland, M. D.
Yamaska, (near Sorel,) 17th May, 1844.
* * * * *
There is no subject, from its importance and interest, within the
extensive range of Surgery, which has more engaged the attention and
labour of eminent and experienced Surgeons, than _injuries of the
head_—injuries, not only involving the greatest obscurity and
uncertainty in their diagnosis, but the sacrifice of human life. It is,
however, to injuries lying entirely beyond the reach of surgical relief,
that I now intend to submit two cases, which, in their nature and
result, completely controvert the generally received opinion, that
_fractures of the basis of the skull are universally fatal_. These, I
must admit, are not of a class upon which discoveries, after death,
might have placed the Surgeon in a position to save life; but such alone
as afford proofs, that _non-interference_, on his part, ought not always
to be reprobated, but may also be sanctioned by the result of
experience.
I am well aware, that where nothing surgically can be added to the
hazard of life, already perilled by certain accidents, nothing can
justify the omission of such means as may bear the least probability of
advantage or success, when accurate, distinctive marks invite the eye
and hand of the skilful operator. Yet, in the absence of these guides,
and when I seriously balance the injuries so often inflicted, and
contrast many of those means in their application to the numerous mixed
and complicated cases of injuries on the head, with a non-interference
of their objects, I am conscientiously borne out, and confirmed in the
opinion, that, to that non-interference alone are many fellow-beings
indebted for their actual existence; and the registers of the Marine
Hospital record the names of hundreds, as irrefragable evidence of the
truth of this startling allegation.
In the following cases, I have omitted the minor details of treatment,
as not connected with the facts I am desirous to illustrate, and even
condensed them in other particulars, in the view of not only affording
room for many important communications from your intelligent
correspondents, but from an intention of preparing for the press, in a
more extended form, the result of practical observations upon injuries
of the head.
* * * * *
James Douglas, seaman, aged 40, was admitted into the Marine Hospital on
the afternoon of the 19th September, 1837. He had fallen from a
considerable height into the hold of the ship. Perfectly insensible;
pulse 30, and intermitting; intense coldness throughout the whole
extremities; a livid appearance on the left side of the face, with
continued twitching of the muscles; breathing in a slight degree
sterterous, and apparently through the nose: pupils of the natural size,
and irides susceptible of light, and tongue pressed against the velum
and palate.
The whole head was examined with much accuracy, but no part of the scalp
appeared lacerated; no depression of bone, no tumefaction, but all
indicated great mischief, concealed in the brain. The following morning,
when I accompanied Dr. Douglas, the case had assumed no change,—the
same pulse, the same twitchings, &c. Towards the evening, the powers of
life were, to all appearances, absolutely sinking; on the third day, the
same; but the tongue had resumed its natural position, and small
quantities of liquids were introduced into the stomach. Thus he
continued, day after day, in a complete state of coma, and _articulo
mortis_, when, to our great astonishment, on the morning of the twelfth
day after his admission, he spoke—in the afternoon, spoke rationally,
and continued rapidly from that period to obtain strength and his wonted
health; and, on the 21st November, was discharged, as fit to join a
corps of volunteers. In that corps, out of his element as a seaman, his
feet and legs became frost-bitten, through long exposure to cold, and he
was readmitted into hospital on the 13th January, 1838, labouring under
very extensive sloughing of these parts, with general debility, and died
three days after.
John Ward, seaman, aged 23, was admitted into the Marine Hospital on the
evening of the 3d October, 1837, in a state of complete insensibility,
with oozing of discoloured matter from both ears and nostrils. He had
fallen from the deck into the hold of the vessel. The head was
attentively examined by the Apothecary, but then no clue was offered to
the concealed mischief. I saw the case, about an hour after: I found a
slight laceration of the integuments, covering the posterior part of the
right parietal bone, but neither fracture nor depression at this, or any
other part of the cranium, could be discovered, after the most careful
examination. Pulse slow, full, but very irregular; there appeared an
alternate dilation and contraction of the pupils, on the application of
different shades of light. The operation of this stimulus was, however,
frequently inverted. He was seen by Dr. Douglas in the early part of
next morning, but with appearances so complicated, contradictory, and
inadequate to offer any diagnosis, that he pronounced it a perplexing
case; but, having in view the preceding one of his namesake, he hinted
to me his conviction of fracture of the base of the skull: he strongly
deprecated the loss of the vital fluid, and enjoined nearly the same
means as were employed in the preceding case, attention being had to the
bowels, with a spare introduction of bland nutritious drinks. I believe
that during my short absence at Sorel, where I had been called, a very
small quantity of blood had been extracted from the back part of the
head.
On the 28th, without any other means than those mentioned, he was
considered so far recovered as to be discharged from the register of the
Hospital; yet, from the circumstance of his ship having sailed, and with
no place of retreat, he was allowed to remain in Hospital, and perform
certain subordinate duties attached to orderlies. This poor fellow,
vigilant to the calls assigned to him by the nurse of the fever wards,
then containing thirty-seven cases of typhus fever, contracted the
disease, and died on the 22d November.
(_To be continued._)
DR. CARTER ON LUMBAR ABSCESS.
Abscesses in the iliac fossa, have generally been described under the
names of psoas or lumbar abscess. They are very often mistaken or
overlooked in their first stage, and frequently their true nature is not
discovered until the period for active treatment is passed. Hence the
universally fatal results that are recorded in the practice of numerous
medical men. The views, which for a long time prevailed, as regards the
pathology of the disease, and which, it would seem, are still
entertained by some, even distinguished practitioners, are, moreover, a
fruitful source of error, and another cause of the inefficiency of the
treatment usually adopted.
The complaint, in almost every instance, is not marked by any prominent
symptoms. The patient seems to enjoy his usual health, and there is
nothing in his outward appearance to indicate the commencement, or even
existence, of a malady, which, if allowed to proceed unchecked, becomes
most formidable in its results, and shows the necessity and importance
of a correct diagnosis; in proof of which, I will merely transcribe what
Dr. Elliotson, of the London University, states in his lectures:—“These
cases are often mistaken for rheumatism; and it is not an easy matter to
make the distinction in the first instance.” And again: “Before seeing
so many of these cases, I have been deceived, and supposed that there
was nothing more than rheumatism, and frequently put down lumbago, when
the case turned out to be one of psoas abscess. I could make no
impression on the disease; the patient has gradually sunk, until at last
he has died,—and on the autopsy, a collection of matter has been
found.” Here, it was very evident, the disease was not suspected until
after death, when dissection proved its nature.
If such a man as Professor Elliotson, whose eminence in his profession,
and whose talents are universally acknowledged, admits to have been
himself frequently deceived, it is surely of the utmost importance to
use every precaution in diagnosis, and to remember the advice he has
given on the subject, viz.: “It is, therefore, a rule with me, whenever
a patient complains of any symptom whatever, to investigate that symptom
to the bottom,—to look round, and see whether there are any other
circumstances about the patient, showing that the symptom is trifling or
something serious.” And yet mistakes are daily committed for want of
this proper scrutiny.
The weakness in the back and loins,—the fatigue in walking,—the dull
pain generally felt in one point, but sometimes shooting to the thighs
and loins,—are referred to rheumatism, lumbago, neuralgia; or, if in a
female, to hysteria or deranged menstrual function. The disease is
treated in the dark: tonics, steel, wine, antispasmodics, and occasional
laxatives, are administered—the usual routine of some practitioners;
who, without giving themselves the trouble of thinking, inquiring, or
examining into all the symptoms, seize some one of them, give it a name,
and treat it according to the most approved methods described in books.
The patient may or may not derive benefit from the treatment; the
physician rests satisfied with the correctness of his first
opinion,—considers it of no consequence, and tells the patient it will
disappear with the warm weather. The disease, in the mean time,
progressively advances,—hectic symptoms supervene; barks, cordials, are
given unsparingly: a large tumor or swelling at length shows itself in
the groin, and then probably too late for any active measures to be
efficacious; the true nature of the disease is discovered,—the patient
lingers out a miserable existence for several months, until, worn out
and debilitated by exhaustion from the immense secretion of matter,
death terminates his sufferings.
The celebrated Dupuytren, the distinguished Parisian surgeon, was the
first to elucidate fully and accurately this hitherto formidable
disease. He demonstrates that it was in many instances, if not
generally, dependent upon an affection of the cœcum. The more we study
the physiology of this organ—its anatomical relations—and investigate
its pathology—the more must we be convinced of the truth of this
eminent man’s views. They are, however, best expressed in his own
words:—
“A long time has elapsed since I have made known the fact of the
development of tumours in the right iliac fossa having an apparently
intimate connection with the parietes of the cœcum. These tumours are
frequently accompanied by remarkable derangement in the functions of the
large intestines. In a great number of cases, they terminate in
resolution—sometimes by an abundant suppuration—sometimes they
constitute the point of origin of a general peritonitis. Thus, in every
point of view, they should be carefully studied. One of the first
questions, then, which presents itself is—Why do they almost invariably
form in the right iliac fossa? Why is the left iliac fossa so rarely
their seat? The answer can only be found in the form of the intestines
and the surrounding parts. Plunged in a mass of cellular tissue, the
cœcum presents at its point of reunion with the small intestine so
marked a constriction, that various foreign substances are apt to
accumulate there, and sometimes become themselves the determining cause
of these abscesses.
“Let us add, that it is in this part the alimentary matters, taking the
excrementitial character, are compelled to circulate contrary to the
laws of gravity, and that it is also in this part that in numerous
diseases, inflammatory alterations are met with. May we not, then,
legitimately conclude, that all these dispositions, natural and morbid,
elucidate occurrence of these engorgements outside the intestine, and
explain their frequency in the right iliac fossa.
“The appearance of these tumours is sometimes preceded by precursory
symptoms. After some error of diet, constipation, diarrhœa-colic, (more
or less habitual),—sometimes without any of these circumstances—the
patient experiences colic and intestinal pain, tending to concentrate in
the right iliac fossa or radiating in the great intestines, or
disseminated over the abdomen. Ordinarily these colics are accompanied
by constipation.
“The symptoms peculiar to the disease are the fixity of the pain in a
very limited point of the iliac fossa, and the tumefaction of this
point.
“Sometimes the fever is rather intense; but in the uncomplicated cases,
no general symptoms of importance usually occur.”
The disease sometimes terminates by ulceration into the cœcum; and the
matter in this way is discharged by the bowels, and the patient is
cured. A case of this kind is mentioned in the 4th volume of Johnson’s
Review. Dupuytren, also, states several instances. Sometimes the disease
terminates in gangrene; and these cases are usually, if not always,
fatal. An instance occurred in my practice four or five years ago: A
man, named Olivier Pratte, a bailiff, after being exposed to
considerable fatigue and exertion in an open boat, during the inclemency
of the weather, was seized with pain and swelling in the right iliac
region. He sent for a quack, who treated it with poultices and emollient
applications, for about ten days. I was then requested to see him, and
found him labouring under all the most alarming hectic
symptoms,—profuse sweats, obstinate hiccup, and vomiting, &c.; all the
lower part of the parietes of the abdomen extending on the right side
over the hip and upper part of the thigh, were in a state of acute
phlegmonous inflammation, and the following day were gangrenous. The
gangrene was prevented from spreading, by circumscribing it with the
nitrate of silver. The hectic symptoms subsided under the use of calomel
and opium, antispasmodics, &c., and the bowels were relieved by
emollient enemata; in this state the man existed for eight or nine
weeks, and appeared at one time to have recovered from all the
formidable symptoms he first laboured under. The gangrenous integuments
became as hard as sole leather, and showed a disposition to separate, by
sloughing from the surrounding healthy structure; his strength was
supported by full nourishing diet; strong broth injections, strong
infusion of cinchona with sulphuric acid, was freely administered, and
for a time he recovered so far as to pick up flesh and strength. This
improvement, however, was but of short duration; the matter had burrowed
deeply beneath the pelvic fascia, and also made its way over the crest
of the ilium and into the lumbar region, dissecting the integuments from
the muscles clean to the spine, and extended downwards a considerable
distance on the thigh. Such an immense secretion and accumulation of
matter soon exhausted the patient, and he gradually sank under its
debilitating effects. Dissection proved the nucleus of the disease to
have been a small calcareous concretion, which existed in the appendix
vermiformis; this, along with the cœcum, was softened and of a slate
colour; the coats of the bowels were much attenuated, nearly diaphanous,
particularly towards their posterior portion; a complete focus of matter
was formed around it, which had deeply burrowed beneath the muscles. The
iliac muscle near the crista Ilii was disorganised, softened, and
absorbed; the oblique muscles of the right side, for two-thirds of their
extent, had been involved in the gangrene, and destroyed; the
transversalis muscle was very much softened, and of a dusky red colour.
At the lower part of the iliac region, corresponding to the internal
abdominal ring, scarcely anything else but the transversalis fascia and
peritoneum covered the abdominal contents. The rectus muscle of the
right side was, as it were, dissected, but otherwise healthy.
It is well understood, that of all structures in the body, cellular
membrane is that which is most apt to take on suppurative action, and
where it exists in greatest abundance and most exposed to irritating
causes, there will abscess most frequently take place; its occurrence in
superficial more frequently than in deep seated cellular tissue, does
not depend on the principle that superficial cellular membrane has a
greater disposition to assume inflammatory and suppurative action, but
that it is more exposed, from its position, to the effects of irritation
and other causes of inflammation, than that which is deeper seated. The
same laws, however, which govern the formation of matter in the
external, it is evident, apply equally to internal structure, and where
we can unquestionably trace long continued irritation in an internal
organ, and moreover are aware that this organ is in close contiguity
with cellular membrane, it is our duty to inquire whether this
irritation has not been followed by organic change. I firmly believe
that many cases of lumbar or psoas abscess originally arise from
irritation and inflammation about the cœcum; and that, were medical men
to be more particular and searching in their inquiries, this insidious
and dangerous disease, from being early detected, would comparatively be
easily cured; the records of surgery would then not abound with so many
instances of its fatal termination.
(_To be continued._)
DR. BADGLEY ON
FOUR CASES OF POISONING BY THE CICUTA VIROSA.
On the afternoon of the 11th of April last, four children, of the
respective ages of 4½, 5, 6, and 6¼ years, wandered into a piece of
ground, which had last year been used as a garden; and, being attracted
by some roots, partly bared of earth, they plucked them, and, fancying,
from their appearance and smell, that they were carrots, or, more
probably, parsnips, they all partook of them,—although, as proved by
the results, in different quantities. Within half an hour, they were all
seized with extreme nausea, burning pain at the epigastrium, and colicky
pains in the bowels: in a word, they all complained, on their reaching
their homes, of “mal de cœur,” for which warm milk was administered to
them all. Efforts to vomit were induced; in one, _full vomiting_ was
effected, but in the other three nothing was rejected from the stomach.
The pains gradually increased in two of them; and, in the space of about
two hours from the time of their eating the roots, they were labouring
under complete coma, with tetanic convulsions,—the jaws rigidly fixed,
profound stertor, and the whole face puffed and bloated, having
precisely the appearance of the head of a person who has been for some
hours under water; pulse intermitting, sometimes imperceptible. The
greatest consternation prevailed in the neighbourhood; and, from the
density of the crowd collected about the house in which one of the
children was, considerable difficulty was experienced in reaching the
door. This, however, was nothing compared to the scene within: the room
was literally crammed with persons; the shrieks of the women rent the
air, and every one was suggesting some remedy to be tried. Being
informed, by the person who came for me, that it was to visit a child
who had been poisoned by something that he had eaten, I hastily put up
about half an ounce of ipecacuanha, and probably a drachm and a half of
sulphate of zinc. Half of these were mixed in a large cupfull of tepid
water; and as it was impossible to administer it by the mouth, it was
poured into the nasal passages, by means of a narrow dessert spoon.
While in the act of attending to this child, a second was brought to the
house, wrapped up in a blanket, in precisely the same state. The
remainder of my stock of emetics was mixed, and divided between the
two—but without the slightest effect. A quantity of mustard was also
administered in the same manner, with an abundant supply of warm water.
Frictions were made over the stomach and bowels. Harassed by the crowd,
overpowered by the heat, and my own stock of medicines being exhausted,
I despatched a messenger for assistance, and a fresh supply. Dr. Nelson
speedily arrived; and, emptying a paper, containing about two drachms of
sulphate of zinc, and as much more of ipecacuanha, into a breakfast
cupful of tepid water, the attack was renewed by us, but with the same
results; and it was at this time that I had ocular demonstration of the
utility of the bent-up spoon recommended by Dr. Nelson. Finding all our
efforts to produce vomiting ineffectual, we applied very copiously a
paste of mustard to the calves of the legs, and over the epigastrium and
bowels; another quantity of sulphate of zinc, (about one drachm,) which
had been brought by a pupil residing in the neighbourhood, was given.
Although vomiting was not induced by these means, it was about this time
that relaxation of the spasms showed itself; and not venturing to add to
the enormous quantity of emetic remedies already prescribed, it was
determined upon to give to each child a dose of croton oil and calomel:
ten grains of the latter, moistened with a very little damped sugar,
were put upon the tongue of each child, and a feather, dipped three
times in a phial of croton oil, was made to lubricate the tongue and
fauces of both. They were left in charge of the young gentleman above
alluded to for an hour and a half; and, on our return, we were delighted
to learn, that one of our little patients had brought up a quantity of,
to all appearance, coagulated milk, and had recovered not only his
sensibility, but power of articulation. No such report, however, was
given to us of the other. During the night, our young deputy gave each
of the little patients castor oil; to the one, about three ounces,—to
the other, about one only. At six o’clock next morning, a message was
sent to the effect, that one of the children was dying, and on our early
visiting this poor little fellow, we found that it was too true; he did
not survive more than three hours. The other child was decidedly better;
but no action of the bowels occurred until 2, P.M., when I administered
an enema of castor oil and spirits turpentine, which produced its effect
within a quarter of an hour, unpacking the intestines of at least two
quarts of a pultaceous, horribly fœtid, olive coloured mass, the fluid
part of which consisted evidently of the enema only, about six ounces.
In fact, the poor child showed, on being lifted into bed, what an amount
of relief he had experienced. From this time, every thing went on most
favourably: a little excitement about the brain continued for two or
three days, but at the expiration of a week, he was perfectly recovered.
But what became of the other two children? He who had eaten most
sparingly of the party, had vomited fully from the warm milk, and, after
a dose of castor oil, was quite well on the second day. Not so with the
fourth. This poor little fellow, after drinking the milk, went out into
the yard. No particular anxiety was felt about him, until the report of
the other children being so ill reached his parents, when a messenger
was despatched for Dr. Nelson, and a search instituted about the
premises for the child. The body was found in a barn, in the rear of the
house—but his spirit had fled.
Francis Badgley, M. D.
W. A. R. G.'s CASE OF CHRONIC PLEURITIS.
TO THE EDITORS OF THE MONTREAL MEDICAL GAZETTE.
Gentlemen,—Should you deem the following communication of a severe case
and unexpected recovery of chronic pleurisy, with effusions, worthy of a
place in your Gazette, you will oblige me by giving it insertion.
October 2, 1836.—Augustin Duval, aged 40, mason, is lying on his right
side, which is oedematous to about three inches in thickness; seems to
be dying from extreme dyspnœa and dangerous faintness; skin of leaden
colour, from deficiency of oxygenation for some time past; pulse 125.
Went a bear-hunting about a month ago; remained all night in the cold
dew, and contracted a severe pleurisy, which was neglected, and
terminated some days ago in symptoms of effusion, filling the right and
partially the left side. He has constantly refused to consent to an
operation, till the 11th, from which time he became very anxious to
submit to any means likely to relieve him. On account of depth of
substances to be cut through, the external incision was of necessity
made more than five inches long, which indeed was barely sufficient to
allow the operation to be got through with ease. Four pints of offensive
purulent matter were evacuated, to the poor patient’s great relief, and
he passed, with the assistance of an anodyne, the first comfortable
night be had enjoyed for a long time.
4th.—Wound almost healed, and chest refilling, so as to threaten a
return of the late disagreeable symptoms, which has induced my sensitive
patient again to have the opening renewed. In the mean time, I was sent
for in a great hurry, and told that he was dying. Found him fainting,
and bathed in upwards of two gallons of serum and pus!
The evacuations from the side continued to the quantity of about a pint
daily, for about two months, and gradually diminished, till his complete
recovery, and ability to support his family by his trade.
There remains a depression of the affected side, and corresponding
hypertrophy of the other lung, which seems quite able to do all the
extra duty imposed on it.
The treatment consisted generally of mercury and opium; acids, to remove
symptoms of hectic fever; preparations of iron, &c.
The appetite was generally keen, and he was allowed as much animal food
as he was inclined to take.
I am,
Gentlemen,
Yours, &c. &c.
W. A. R. G.
DR. BIBAUD's
CAS REMARQUABLE D’ADHÉSION DU PLACENTA.
Messieurs,—Si la communication suivante vous semble de quelqu’-intérêt,
vous m’obligerez en l’insérant dans votre Gazette Médicale, déjà si
intéressante par les matières qu’elle renferme et la manière habile dont
elle est rédigée, et qui mérite, à juste titre, d’être encouragée par
les souscriptions et les écrits des médecins franco-canadiens.
J’ai l’honneur d’être,
Messieurs,
Votre humble et obéissant serviteur,
J. G. Bibaud, M. D.
* * * * *
Le jeudi, 15 février, dernier, à quatre heures du matin, je fus appelé
auprès de la femme de J. L., pour un accouchement. C’est une femme agée
de 36 ans, d’un fort tempérament et bien conformée, qui accoucha de son
premier enfant à 34, après un travail long et pénible où il fallut
employer les forceps.
Lorsque je la vis, cette dernière fois, l’accouchement s’offrait avec
les circonstances suivantes: la malade avait ressenti, la veille, les
premières douleurs; la poche des eaux s’était rompue le même jour et le
fluide s’était écoulé en partie. En examinant, _per vaginam_, je trouvai
l’orifice utérin de l’étendue d’une piastre d’Espagne. Peu après, il
s’effaça entièrement et la tête éprouva son mouvement de rotation pour
venir se placer dans l’axe du détroit inférieur, en première position.
De ce moment je m’attendais à voir l’accouchement se terminer bientôt,
car les douleurs devenaient énergiques. Cependant, elles se répétèrent
pendant plusieurs heures, à des intervalles rapprochés et avec la même
vigueur sans que la tête fit plus que se présenter sous l’arcade
pubienne. Vers les 11 heures, m’appercevant que le travail ne faisait
presqu’aucun progrès et les efforts de la matrice semblant se ralentir,
je proposai l’application des forceps. La malade en fut alarmée, ce qui
m’engagea à demander l’opinion de mon ami le Dr. R. Ce monsieur, après
l’examen, jugea convenable de retarder quelque tems. Je me rendis à son
avis, et afin de donner à cette femme toutes les chances d’enfanter par
les seules forces de la nature, j’attendis encore jusque vers les trois
heures. Alors, voyant que les choses restaient dans le même état, je
terminai l’accouchement par les fers; ce qui fut fait dans une dizaine
de minutes.
Après la sortie de l’enfant, la matrice ne se contracta pas et le
placenta demeura implanté à son fond. Comme il n’y avait pas de
tranchées, j’espérai quelque tems, après quoi je pratiquai de légères
tractions sur le cordon dans l’axe du détroit inférieur: manœuvre que je
répétai deux ou trois fois dans l’espace d’un heure, sans succès. Je
jugai, alors, à propos de faire la délivrance sans plus de délai. Je fis
des tractions plus fortes et je parvins ainsi à décoller le placenta en
partie. Il s’en suivit aussitôt une hémorrhagie alarmante qui m’obligea,
tout en continuant les tractions, d’employer les moyens les plus
capables de faire revenir l’utérus sur lui-même. Mais, ces moyens
n’ayant eu que l’effet de diminuer un peu l’hémorrhagie, j’introduisis
la main au fond de cet organe, et à mon grand étonnement, je rencontrai
une adhérence extrême du placenta dans presque toute son étendue. La
difficulté que je devais rencontrer à en faire le décollement et les
conséquences fâcheuses que je savais en pouvoir résulter, ne me
permirent pas d’en prendre sur moi toute la responsabilité. Je rappelai
donc le Dr. R. Après s’être assuré par lui-même de l’étendue de
l’adhérence morbide, il me dit n’en avoir pas rencontré de semblable
dans toute sa pratique, quoique très étendue dans cette branche. Il
fallut extraire une grande partie de la masse placentaire par petits
morçeaux, offrant à leur surface utérine une couche fibrineuse dense.
Cette femme me dit avoir ressenti de la douleur, dans les derniers mois
de sa grossesse, à l’endroit correspondant à l’implantation du placenta;
ce qui donne à supposer qu’il y à eu une action inflammatoire à cet
endroit de la matrice.
Pour se rendre compte de l’empêchement à sortie de l’enfant, il faut
remarquer qu’outre l’adhérence du placenta, le cordon était entortillé
autour de son col; incident qui me persuada que j’avais pris le parti le
plus sûr en accélérant l’accouchement. L’enfant vint au monde asphyxié
par congestion de sang au cerveau, ce qui s’explique par la circonstance
ci-dessus, et par son séjour prolongé dans le bassin de la mère. Après
avoir laissé couler une couple de gros de sang par le cordon, il sembla
se ranimer; mais, il était si foible qu’il expira peu après.
Il s’est rencontré des cas de rétention du placenta où son décollement a
été impossible. Et même, il est des accoucheurs qui se mettent peu en
peine de l’extraire, si la nature ne s’y prête. Quant à moi, je ne puis
regarder cette pratique que comme dangereuse, à moins, cependant qu’on
n’ait été appelé fort tard, lorsqu’il y à déjà inflammation ou beaucoup
d’irritation de la matrice. Car quoiqu’il soit arrivé, qu’une portion
assez considérable du placenta et même tout cet organe ait été retenu,
sans qu’il en soit résulté d’accidens, cependant, est-il vrai de dire,
que, le plus souvent le contraire à lieu. Il est évident, que tant
qu’une partie de l’organe temporaire demeure adhérente à la matrice elle
ne peut se contracter efficacement, et ainsi il est toujours à craindre
que l’hémorrhagie ne se déclare et n’enlève la malade avant que le
médecin ait pu venir à son secours. Il me semble, en outre, qu’il est
moin facile de prévenir l’absorption des matières putrides qui stagnent
dans l’utérus que l’inflammation de cet organe, qui peut être la
conséquence de l’irritation que nécessite le décollement. C’est cette
dernière forme de fièvre puerpérale que j’eus à craindre dans le cas que
je viens de rapporter. Mais par un régime antiphlogistique rigoureux,
j’eus la satisfaction de la prévenir.
REPORT OF DR. SKENE ON LEPROSY.
TO THE EDITORS OF THE MONTREAL MEDICAL GAZETTE.
Herewith I send you a report of the “Leprous Disease” prevailing in the
neighbouring Province, drawn up by my friend Dr. Skene, Assistant
Surgeon of the 52d; and you are at liberty to make use of it for your
periodical, if you think fit.
Respectfully yours,
J. Spence.
Kingston, May 21, 1844.
* * * * *
Fredericton, N. B., _25th April, 1844_.
_To Sir_ JAMES McGRIGOR, _Bart., Director General of the_
_Army Medical Department_.
Sir,—Having been appointed by the Lieutenant Governor of New Brunswick,
one of a Commission, consisting of Doctor Toldervy, of Fredericton,
Doctor Key, of Chatham, Doctor Gordon, of Bathurst, and the Reverend Mr.
Lafrance, P. P. of Tracadie, to investigate the condition of Tracadie
and the adjoining districts, with reference to a malignant Disease
reported to prevail therein, I have to state, that having, in terms of
the above mentioned Commission, proceeded to the districts in question,
the Disease alluded to proved to be the “Tubercular Leprosy,” or “The
Elephantiasis of the Greeks.”
On comparing the symptoms of the cases submitted to us, with those of
the “_Lepra Tuberculosa_,” in Bateman, Simpson, Copland and others, I
satisfied myself that this Disease was THE (Tubercular) Leprosy, and
that their descriptions of it left little to be desired.
Deeming myself particularly fortunate in having thus had an opportunity
of personally observing a Disease so rare and so little known to British
Authors, and one which presents numerous points of enquiry to the
philosophic mind, I have thought it best to confine my remarks:
_First_—To the proof that the cases observed were really the Lepra
Tuberculosa of Authors: _Second_—To the particular points still at
issue in regard to the history of this remarkable malady.
In regard to the first point, I shall quote the definition (of this
Disease) of Doctor Copland, Page 701, of his valuable Medical
Dictionary—
“_Defin_:—Dusky red or livid tubercles of various sizes on the face,
ears and extremities; thickened or rugous state of the skin, diminution
of its sensibility, and falling off of the hair, excepting that of the
scalp; hoarse, nasal or lost voice; ozœna; ulcerations of the surface,
and extreme fætor.”
This definition will I think be amply borne out by the following cases
selected from _nineteen_ which came under my own observation:—
1.[1] Frances Savoy, Ætat. forty six, a married woman, with a family of
six children. When I saw this patient on the 28th of March last, she
presented the following appearance.—The surface of the skin seemed as
if smeared over with oil; the whole of the face was studded with
tubercles, varying in size from that of a pepper corn to that of a large
bean, the larger ones about the lower part of the face, where they
became confluent, and caused much enlargement of the lips, and the
cheeks to be pendulous. This enlarged mass, particularly under the chin,
is divided by numerous rugæ, more especially by a transverse one larger
than the others, giving or causing the appearance of what is commonly
called “_double chin_,” in a very decided manner; Nose very much
enlarged, also pendulous, with ulcerations commencing at the lower part;
Mucous membrane excessively thickened; Eyebrows devoid of hair, and that
of the cilia entirely disappeared; voice husky, (hoarse) and nasal; the
whole of the inside of the mouth and fauces studded with tubercles of
various sizes, confluent about the velum and uvula, breath intolerably
fœtid; many tubercles of various sizes were seen on the upper and lower
extremities; respiration short, and she coughs a good deal; pulse eighty
and rather small; sleeps well and eats well; Disease first made its
appearance four and a half years ago; suffers little or no pain. Her
husband is in perfect health, and sleeps with her every night, but one
of her sons, a boy eight years of age, is affected with same Disease.
2.[2] Tranquil Robicheaux, a boy aged fifteen. The patient presented the
following appearance on the 29th of March, 1844:—The whole of the face
much swelled, and presents a shining glossy appearance, as if smeared
over with oil; studded with tubercles, very large about the lower part
of the cheeks and chin; tip of the Nose pendulous and abraded, with a
livid _shining_ tubercle; Lips _enormously_ enlarged, and full of small
tubercles on the inner sides, which have the appearance of small
cicatrices on their summits; Tongue much thickened and protruding
between the Lips, full of tubercles, with numerous fissures crossing
each other in different directions; Palate, and whole of the fauces
thickly covered with tubercles, small and confluent; Voice a mere
whisper, and when raised by extraordinary exertion, not like that of a
human being; uvula and tonsils extensively tubercular, in fact one mass
of disease extending down into the pharynx; constant cough; Breath very
offensive; hair from Eyebrows and cilia entirely disappeared; extensive
ulcerations on the calf of the left leg, and also on the right instep,
with incipient ulceration about the roots of the nails; large oblong
tumour in either groin, presenting somewhat the appearance of Femoral
Hernia; four large but superficial ulcers on the left thigh, with
thickened and indurated edges; Trunk of the body free from tubercles;
sensibility of all the diseased parts very much impaired, if indeed not
entirely destroyed, inasmuch as I pinched them as hard as I possibly
could, without inducing pain; sleeps indifferently; appetite good, and
digestive organs apparently unimpaired; Disease commenced six years ago;
his uncle died of the disease about a month ago in, I am told, a
shocking state.
3.[3] Peter Savoy, Ætat. 33, married, wife and four children, all of
whom apparently healthy, presented the following appearance on the 2nd
of April, 1844:—Countenance of a dirty livid complexion, mottled and
shining as if smeared over with oil: tubercles of various sizes studded
over the forehead, smaller on the upper part of right cheek; Nose much
swollen, with an enlarged state of the left _ala_ more particularly,
which is of a livid colour, and possessing a very glossy surface; upper
Lip full of tubercles, which are superficial, and give the mouth a
corrugated appearance; Eyebrows much enlarged and overhanging, devoid of
hair, that of the cilia almost wanting; Conjunctiva slightly injected;
Skin of Eyelids, and that covering malar bones of a yellowish, _coppery_
or tawny colour; a large tubercle arising from the septum, filling up
the left nostril; Mucous membrane much thickened; Palate of a darkish
yellow, and in some places of a livid colour; Breath extremely fœtid;
Voice hoarse and husky; Ears tubercular and pendulous; Chest and Arms
covered with livid blotches; tubercles thickly studded over the outer
and posterior surfaces of his forearms, one or two on the right have
suppurated, and are now covered with dark scabs with white scaly edges;
Hands dry and shrivelled, with skin on the palms horny and cracked;
Nails tolerably healthy; Lower extremities (thighs and legs) covered
with same livid blotches as those described on the Arms; state of the
Feet same as that of the hands. He states that seven or eight years ago
he fell out of health, and became affected with apathy, debility and
drowsiness, and slight irritation occasionally in the skin; these
symptoms continued for two or three years, and blotches shewed
themselves on the face, chest and extremities, of a darkish yellow
(tawny) colour, which in the course of some months became of a _dusky
red and livid colour_. These were followed, in the course of nearly
twelve months, by the appearance of tubercles, (or lumps as he described
them); the first developed itself over the left eye, and have extended
since, as has been described.
4. Alexander Stewart, Ætat. forty-nine, single, presented the following
appearances on the 3d of April, 1844:—Complexion dirty and unhealthy,
and the surface of the skin seems as if smeared over with oil; Face
mottled, studded with flattened tubercles, none very superficial; whole
of the integuments thickened with uneven surface; Eyebrows full and
drooping, perfectly devoid of hair; that also of the cilia almost gone;
Lips thickened and full, and their inside covered with small tubercles
with white summits. The whole of the Throat and Palate covered with
tubercles with superficial ulceration, and extending down the pharynx as
far as can be seen; two or three tubercles on the back part of the
Tongue, which is much thickened; Breath very fœtid;—Voice a mere
whisper, with laborious breathing; occasional cough, with a bloody
mucous expectoration. His beard is so thin that he can go three weeks
without shaving, and suffer no inconvenience therefrom; the whole
surface is covered with a dark reddish eruption, more particularly on
the upper part of the chest and extremities, [here the peculiar oily
appearance is well marked;] Skin of Hands much shrivelled and cracked;
Toes swollen, colour livid and glossy; Nails furfuraceous and almost
gone; several detached tubercles on the instep and back part of Legs;
great want of muscular power; the sensibility of the surface is very
materially diminished, pinching the integuments of the face and
extremities, causing little or no pain: to use his own expression, “my
flesh seems as if it were dead.” Appetite good, but passes very restless
nights, and is altogether in a very debilitated condition. He states,
that about eight years ago a rash appeared on his body, which was
considered by his friends to be the Itch; this rash was confined to the
extremeties. In the course of some four months, it in a degree
disappeared, and was followed by swelling of the whole of the
integuments, and some of the glands in his neck became enlarged, and
numerous tubercles (or lumps, as he called them,) presented themselves
upon his face, and have since gradually spread.
I trust that the foregoing extracts from our “case book” will satisfy
you that the Disease which we saw is identical with the Tubercular
Leprosy which prevailed throughout Europe during the middle ages, and
which has more recently been seen in Iceland, the Farroe Islands,
Shetland, Madeira, Holstein, the Crimea, Africa, Ceylon, (vide Staff
Surgeon Kemmis, paper Ed. Med. and Surg. Journal, No. 52,) and the East
and West Indies.
The new locality for this Disease forms a part of the Province of New
Brunswick. It is chiefly confined to the east side of the land lying
between the Bay of Chaleur and the estuary of the Miramichi River, and
more particularly to the Settlements on the Neguac and Tracadie Rivers.
We could not draw any _positive_ conclusion as to the original
appearance of the disease in this quarter; but from the statements
submitted to us by some of the oldest settlers, we learn that the first
case occurred about the year 1817, in the person of a woman named Ursule
Landré, one of a family of nineteen children. The father of this family
is supposed to have been an Acadian, and married a woman of Caraquet, of
the name of Mary Bredeau. This Ursule Landré, one of his daughters,
married a man of Tracadie, of the name of Joseph Benoit, about the year
1798 or 1799. Ursule and her husband came to reside in Tracadie
immediately after their marriage, and had five children, three
daughters, and two sons. She is known to have been a perfectly healthy
woman until after the birth of her youngest child, which took place in
1809. She continued in delicate health for six or eight years, and it
was observed about this period that _spots_ or _blotches_ developed
themselves on the face, extending over the upper part of the trunk and
extremities. After a lapse of time distinct lumps (as they described
them) appeared on the face and on the inside of the lips and in the
throat. She lost the hair of her eyebrows and eyelashes; Voice became
hoarse and husky; and, in short, she appears to have exhibited all the
characteristic symptoms of the disease, and died in 1829. Joseph Benoit,
her husband, took the disease three or four years before her death, and
sank under it in 1831. From these cases, the disease would appear to
have gradually extended itself, and although ten or eleven years ago
only two cases existed, we found, independent of seven deaths[4] which
have occurred, thirteen confirmed cases and three highly suspicious
ones, in Tracadie; four confirmed cases in Neguac, and one confirmed
case in Tabisintac; and one (Alexander Stewart) eighteen miles up the
North West Branch of the Miramichi River; making in all nineteen.
(_To be continued._)
Footnote 1:
One of the Neguac cases.
Footnote 2:
One of the Tracadie cases.
Footnote 3:
Was seen in the Tracadie district on the 2d of April, 1844.
Footnote 4:
These deaths are exclusive of five others, who are known to have
contracted the disease in Tracadie, but died elsewhere. Doctor Key saw
these cases, and most positively asserts that they died of this disease.
* * * * *
THE MONTREAL MEDICAL GAZETTE.
Omnes artes, quæ ad humanitatem pertinent, habent quoddam
commune vinculum, et quasi cognatione quadam inter se
continentur.—_Cicero._
MONTREAL, JUNE 1, 1844.
* * * * *
THE EDITORS' ADDRESS.
The ceremony of conferring the degree of Doctor in Medicine and Surgery
took place on Saturday last, 25th May, at McGill College, on which
occasion seven gentlemen received the “summos honores.”
We are personally acquainted with several of these gentlemen, and we
feel that we are not going too far in predicting that they will prove as
successful Practitioners as their examinations have testified to their
having been zealous and attentive Students. The day must have been a
proud one to the Candidates, and no less gratifying to the Professor and
Lecturers of the Faculty, whose lessons and instructions they have been
following.
The order of the ceremony was simple enough. The Chair having been taken
by the Principal, the Vice Principal and Members of the Convocation
being seated on either hand, the Candidates were introduced; and, after
repeating with the Registrar a pledge that they would, practise their
profession, cautè, castè, probèque, and that they would not, without
“gravi causa,” do aught to injure their alma mater, “hunc collegium,”
their names were duly registered on the books of the University. They
were now presented to the Principal, by whom they were “capped”—that
is, endued with the power of practising medicine and all the branches
appertaining thereto. This was the most interesting part of the
proceeding: the Candidates were all in the attitude of prayer—kneeling
before the Principal—and as the name of the Blessed Trinity was
pronounced, each bowed his head, in token of humility and of
thankfulness.
The M.D.s were then congratulated by the Caput and Members of the
College, and took their seats on the platform.
A continuation of the day’s proceedings, yet more impressive, was to be
enacted—the granting of the degree of Divinity on the Rev. D. Falloon,
Minister of the Free Chapel, Griffintown, and of the degree of Doctor in
Civil Law on the Honourable Chief Justice Vallières de St. Real and
William Badgley, Esq. Each Candidate was presented to the Principal by a
sponsor, who read the petition of the party, detailing, at the same
time, his qualifications for the honour. The latter of these gentlemen,
we believe, has accepted the Chair of Lecturer of Civil Law in the
University.
The language used throughout was that of Rome; but we regret that by far
the greater part was perfectly inaudible; a word here and there was all
that could be made out,—even the Principal, with his usually sonorous
voice, was with difficulty heard where we stood.
Great disappointment was felt because of there not having been an
address spoken, either by the Principal or the Professor of Practice of
Medicine. On previous occasions, we have heard that which well repaid
the trouble of having gone to hear, and we, with many others, missed
that which was wont to be considered an essential part of the day’s
ceremony.
The following are the names of the gentlemen who received their
diplomas, together with the subjects of their theses. We wish them all
joy and every success:—
W. E. Scott, of Montreal, on _Peripneumonia_.
W. H. Wagner, Osnabruc, C.W., _Hæmoptysis_.
Alexander Long, Montreal, _Oblique Inguinal Hernia_.
P. Proulx, Boucherville, _Rubeola_.
R. Holden, of Belleville, C.W., _Pneumonia_.
E. H. Trudel, Montreal, _Hydrophobia_.
R. Godfrey, Montreal, _Blood-letting_.
* * * * *
The first two numbers of a new periodical, holding a position
intermediate between the daily and other journals and our own,—have
made their appearance. The _Gazetteer_ occupies a middle place between
these two classes, both as to matter and periods of
publication—embracing medical, legal, literary and commercial subjects,
and being issued twice a month.
We offer the Editors our congratulations, and hope they will receive
every encouragement from the classes to whom they have appealed.
We beg to assure them that the reports of which the leader of the second
number complains have not reached us, and that we therefore, could not
have formed an “erroneous opinion” on the subject. Were these reports
correct we would not have felt anything like anxiety; on the contrary,
great satisfaction would have been experienced: we would now prefer, as
far as we ourselves are concerned, that there did exist a connexion such
as that spoken of in the Gazetteer.
We again offer our good wishes to the Gazetteer, and feel the truth of
the words “irrupta tenet copula” and “nil humani a nobis alienum
putamus.”
* * * * *
We have received the following communication, in relation to the
proceedings on Saturday last, at McGill College, and we gladly give it
insertion. Our own version had been handed to our publishers previously
to our reception of the subjoined. Had it been otherwise, we would have
withdrawn it.
McGILL COLLEGE.
On Saturday, 25th of May, the ceremony of graduating the successful
Candidates for the degree of Doctor of Medicine and Surgery, was
performed. On that day, seven gentlemen, who had completed the
curriculum of study required by the statutes, and who had undergone the
various trials appointed, were admitted to the Doctorate. Of these,
three had already graduated in the United States.
The names of the Graduates are:—
Rufus Holden, of Belleville, C.W., (M.D. of Pennsylvania College,)
Thesis, _Pneumonia_.
William H. Wagner, of Osnabruck, C.W., (M.D. of Jefferson College,
Philadelphia,) _Hæmoptysis_.
Phileas Proulx, of Boucherville, C.E., (M.D. of Albany College,)
_Rubeola_.
Alexander Long, (Licentiate of the Royal College of Surgeons of
Glasgow,) _Oblique Inguinal Hernia_.
William E. Scott, (Provincial Licentiate,) _Peripneumonia_.
Robert Godfrey, (Provincial Licentiate,) _Blood-letting_.
Eugene Hercule Trudel, of Batiscan, C.E., _Hydrophobia_.
This is _the same number that graduated last year_.
Since the revival of the Medical Lectures in 1837, there has been a
regular progression in the number of pupils attending this school, and
the “matriculations” of the last session exceed those of any preceding
one; fifty-three students having enrolled their names in the “Matricula”
of the Medical Department. The fees of “Matriculation,” as well as those
of “Graduation,” are devoted to a fund exclusively appropriated to the
purposes of the Library of the Medical Faculty, which is open to the
Students without any charge. Ninety-nine volumes, of which nineteen are
French, have been added since May last, and the total number now on the
shelves is about 760, among which are most of the latest and best works,
on the various departments of Medical Science.
During the last session, an important addition has been made to the
Medical Department of the University, viz.: a Lying-in Hospital, in
which Students who have attended one course of Midwifery, have an
opportunity of becoming practically acquainted with that necessary
branch of the profession. The number of patients admitted since it was
first opened, in November last, is 28; and it has been heretofore
supported by the Lecturers themselves, aided only by the donations of a
few of their friends. It is hoped, also, that it may be useful in
training Midwives for the proper exercise of their profession.
ADDRESS OF STUDENTS TO OUR SCHOOL.
AUX EDITEURS DU JOURNAL MEDICALE.
Lorsque j’adressai, à la clôture de nos cours, à la nouvelle école
médicale, un discours à nos professeurs, mon intention n’était pas de le
publier, mais à la grande solicitation de plusieurs de mes amis, j’ose
vous demander humblement un petit espace dans vos colonnes pour l’y
insérer.
Messieurs,—Nous croirions manquer au devoir le plus sacré, si nous
laissions finir nos cours sans élever la voix pour vous témoigner notre
reconnaissance.
Chacun de nous aurait désiré avoir l’honneur de vous adresser, à sa
manière son petit compliment, mais nous avons pensé que cela pourrait
vous être fastidieux et nous sommes convenus qu’il n’y en aurait qu’un
seul qui élèverait la voix et serait l’organe de tous les autres.
L’heureux hazard à voulu que ce fût moi, il est peut-être tombé sur
celui qui est le moins capable, du côté des _talents_, de se bien
acquitter de ce devoir, mais, messieurs, quand on à traîter un sujet de
cette nature, les expressions viennent comme d’elle-mêmes. Aussi,
bienfaisants professeurs, je suis persuadé que ce ne sont pas tant les
expressions recherchées que vous prisez que les sentiments d’un cœur
reconnaissant qui met en œuvre, en cette circonstance agréable, les
foibles talents qu’il à reçu de la _nature_.
Messieurs, votre dévoûement et le zèle infatigable dont vous avez fait
preuve depuis le commencement de nos cours, vos veilles, vos travaux
continuels et votre assiduité à nous inculquer les différentes branches
tant de la médecine que de celles qui y ont rapport, votre grande
attention à nous aplanir les difficultés sans nombre qu’on ne cesse de
rencontrer dans la pénible _carrière_ que nous avons embrassée, les
obligations que nous vous avons pour nous avoir introduits dans cette
belle carrière; vos grands et généreux efforts à nous y introduire comme
par la main et à nous y faire avancer le plus rapidement possible,
toutes ces considérations, messieurs, exigeraient, de notre part, des
présents plus précieux que l’or et l’argent; mais, messieurs, il me
semble de lire sur vos nobles figures que de tels présents ne sont
d’aucune valeur aux yeux d’hommes généreux et dévoués comme vous; non,
certainement, non; plus d’une fois vous nous avez donné des preuves de
votre désintéressement; ce sont, au contraire, les sentiments d’un cœur
reconnaissant que vous prisez. Eh bien! messieurs, puisque ces présents
vous paraissent si agréables, nous vous prions de les recevoir et de
croire qu’ils viennent du fond de nos cœurs. Recevez, illustres
professeurs, le tribut de reconnaissance et de gratitude que nous vous
devons pour tous les bienfaits que nous avons reçus de vous. Tout notre
regrèt, aujourd’hui, messieurs, est de n’avoir peut-être pas correspondu
à vos efforts à nous instruire et d’avoir été, peut-être, comme l’homme
ignorant et grossier qui ne sait pas distinguer la pierre précieuse du
grain de sable qu’il foule aux pieds; mais, je suis persuadé d’avance
que vos cœurs sont aussi disposés à nous pardonner que l’est celui d’un
bon père envers ses enfans.
C’en est assez, messieurs, nous laisserons parler nos cœurs; leur
langage est plus énergique que la bouche la plus éloquente. Je me
contenterai seulement d’adresser, avec votre permission, quelques mots à
ceux qui ont partagé avec moi vos bienfaits.
O! _mes compagnons, mes amis, mes frères_, n’oublions jamais la
sollicitude et la bienveillance de nos _bienfaiteurs_, et lorsque plus
tard, nous serons appelés auprès de quelques _patiens_, si avec le
secours de l’art, nous réussissons à les rendre à la vie et à la santé,
gardons-nous bien de nous en attribuer tout le mérite, pensons aussitôt
que cette gloire nous vient de nos _illustres professeurs_, qui sauront
bien eux-mêmes la faire remonter jusqu’à celui qui donne et fait croître
les _talents_.
BRIEF NOTICES.
We have been requested to state to the members of the Medico-Chirurgical
Society—that the meetings will be held monthly during the summer—till
the month of November, at which time they will again be every
fortnight—medical men residing in the country are invited not only to
visit, but to take _part in the proceedings of, the Society_.
* * * * *
There was a meeting of the District Medical Board of Examiners on the
7th May—being their quarterly day of assembly—at which the following
five gentlemen, having passed creditable examinations received
certificates for licences to practise the several branches of the
profession—
Francis Robineau of St. Thérèse de Blainville; Hyacinthe Beauchemin of
Nicolet; Louis Laurier of Mascouche;——De Rosier of Ste. Hugue and
Augustus Régnier of Montreal.
* * * * *
We have in this number, taken from the Medico-Chirurgical Transactions
of London, a case of Sir Benjamin Brodie’s—whose authority and language
supply us with an apology for inserting it as it appears.
* * * * *
The history of four cases of poisoning, produced by the Cicuta Virosa,
appears in our number of this month, and will be found interesting in a
pathological point of view, as demonstrating the fact of the enormous
quantities of emetics which may be administered without producing their
specific effects, when the system is thus narcotized. The stomach was
not the only organ rendered insusceptible of stimulation: in the
instances recorded, the pupils were obliterated—the irides scarcely
visible and immovable. The violent remedies passed through the nostrils,
and those subsequently applied to the tongue and fauces of the boy who
recovered, produced not the slightest local irritation: on the fourth
day he was in every respect well.
ERRATUM.
In Dr. Crawford’s paper on Medical Statistics, in our last number, page
39, second line from the bottom, for “out of every 100 troops,” read,
“out of every 1000 troops,” &c.
TO CORRESPONDENTS.
Dr. Wight’s case was received too late for this month’s impression; it
shall appear in our next number.
Z. is again unavoidably postponed; we hope that he will not be
displeased.
Dr. Dubé’s wish has been attended to.
The continuation of Dr. Crawford’s article in our next.
Dr. C. Carter’s remarks will be concluded in the July No.
Dr. Cartier’s instructions will be seen to.
MEDICO-CHIRURGICAL SOCIETY’S ROOMS.
_30th March, 1844._
Dr. Fisher, in the Chair.
[We publish this case in the Doctor’s own words—long though it
be—because we find that any abridgment would materially affect the
description and animus of the history.]
Dr. Fisher related the following case:—
I was requested to visit the subject of this case, during the summer of
1842. I found her emaciated to the lowest degree. She showed
considerable curvature of the spine, and there was a constant discharge
of a thin greenish pus from an opening near the lower margin of the left
side of the thorax. This opening, I was soon satisfied, communicated
with the cavity of the chest. Little could be done in the way of
treatment; the administration of tonics, with due regard to the state of
the bowels, constituted the chief of my therapeutic means. There was
little or no cough. For some weeks, I daily expected to hear of her
death. Things continued in this state for two or three months, when her
mother directed my attention to a considerable tumour, yielding a
distinct fluctuation just above the crest of the ilium, and close to the
spine of the left side. I opened the abscess by a pretty free puncture,
at my next visit, and obtained half a slop basinful of matter, similar
to that issuing from the opening in the thorax. For some time, both
openings continued to discharge, and she became gradually weaker. I
entertained no hopes of her life; at length, however, the discharge
diminished very much; she gradually regained her strength, and, to all
appearance, recovered entirely. The last time I saw her, on account of
that illness, was in the spring of 1843, when she had walked from
Salaberry street, in the Quebec Suburbs, to my house; she was then in
good condition,—indeed she was fat. About six weeks ago, her father
called upon me, and requested that I would see her again. I then heard
that she had been ill a week, with her old complaint. She had much
fever, was exceedingly weak, coughed considerably, and expectorated a
white mucus. On examining the chest, I discovered a slight puffiness a
little below the left clavicle. Percussion yielded a dull sound over a
great part of the left half of the thorax, and the metallic tinkling was
distinct, accompanying cough and speech. The part below was not
affected; she felt no pain or other peculiar sensation in the part. I
prescribed a blister to the chest, and calomel and opium internally. At
my next visit, I found that the puffiness had disappeared, but in other
respects she was worse. The dull sound on percussion extended over the
whole of the affected side; the metallic tinkling had disappeared. She
fluctuated for a week, at the end of which time she died. During the
last day or two before death, she had slight intervals of delirium; she
had also a great deal of vomiting of a dark brown watery matter, and
little or nothing could be retained on her stomach; she also passed, at
intervals, large quantities of the same matter by the bowels: this was,
however, darker coloured, and yielded a sediment resembling coagulated
blood. During the whole of her illness, she had little or no dyspnœa;
the pulse was uniformly small, although it varied in rapidity.
On post mortem examination, the body was found much emaciated; the
curvature of the spine was distinct, but not so great as it had appeared
during life. On removing the integuments from the costal cartilages, pus
unexpectedly escaped, and an opening through the intercostal muscles,
pleuræ, &c., into the chest was discovered; continuing to remove the
integuments, pus again gushed out from a similar opening lower down. On
removing the sternum and cartilages, upwards of three pint basinsful of
pus were evacuated. This had completely filled the left cavity of the
pleura, and had compressed all the air out of the left lung, which was
found pressed almost as thin as a membrane, against the vertebræ and
pericardium. The pleura was generally found thickened; its surface
rough; in fact, ulcerated and covered with pus considerably thicker than
that which ran out. After the removal of the pus, the cavity of the
chest was found to communicate with an abscess extending along the left
crus of the diaphragm and psoas muscle down to the crest of the ilium.
The communication was established by means of an opening through the
diaphragm, nearly the size of a dollar. The roots of the lumbar nerves
were beautifully dissected. The right lung was perfectly healthy. On
raising the left lobe of the liver, an adhesion between it and the
duodenum was ruptured, and an ulceration of the latter exposed, through
which the contents of the bowel escaped; an oval ulceration of the
corresponding surface of the liver, which just fitted the pulp of the
finger, was discovered. A similar adhesion had taken place between the
duodenum and pancreas, but of much greater extent, the perforation of
the intestines being at least two inches in diameter. The intestines
were generally very much contracted, but seemed otherwise healthy. The
liver was double its normal size, and rather friable. The pericardium
was found adherent to the heart, throughout its whole extent.
Dr. Fisher exhibited morbid preparations of this interesting case.
AN ACCOUNT OF A CASE IN WHICH A FOREIGN BODY WAS
LODGED IN THE RIGHT BRONCHUS.
_By Sir Benjamin C. Brodie, Bart., F.R.S., Sergeant-Surgeon to the_
_Queen, etc., etc._
READ JUNE 27TH, 1843.
I am induced to communicate the following history to the Royal Medical
and Chirurgical Society, believing that it embraces some points of
considerable practical importance, which may be deemed not unworthy of
their attention.
On the 3rd of April 1843, Mr. B. being engaged immediately after dinner
in amusing some children, placed a half-sovereign in his mouth. By some
accident it slipped behind the tongue, and a violent fit of coughing, in
which he had the appearance of being nearly choked, was the consequence.
This was immediately followed by vomiting, the contents of the stomach
being ejected with considerable force. He strained two or three times
afterwards, but did not again vomit. In the course of the evening he
coughed at intervals: but the cough was not violent. A sense of soreness
and stiffness of the throat remained for the first twenty-four hours. He
experienced little or no inconvenience during the two following days. He
was not observed to cough, and he employed himself as usual, being able
to entertain some friends at dinner.
On the 6th of April, he was again troubled with a cough. On the 7th he
went on a journey into the country, and was more or less exposed to a
cold north-east wind for two days and nights. The cough now became
aggravated. He expectorated some mucus slightly tinged with blood, and
small portions of a substance answering to the description of a thin
membrane. He experienced, also, a pain in the right side of the chest,
referred to a spot corresponding to the situation of the lower portion
of the right bronchus.
On the evening of the 9th of April, he took two aperient pills, one of
which was ejected by vomiting some time afterwards. In the act of
vomiting, he experienced a sensation as if a loose substance had shifted
its place in the chest; and for some time afterwards the cough was much
relieved, and the pain in the chest entirely ceased.
On the 11th of April, the cough was again troublesome. There was little
or no expectoration. At this time the chest was repeatedly examined,
with the stethoscope by Dr. Seth Thomson, but no unusual sounds were
detected in any part of it.
On Monday the 17th of April, Mr. B. again went into the country, exposed
to a cold easterly wind. On his return to London, the cough was again
much aggravated.
On the 18th of April, by the advice of Dr. Seth Thompson, he consulted
Dr. Chambers, and afterwards myself. Prom the detail of the symptoms, we
were all of us led to believe that the half-sovereign had passed into
the trachea, and that it remained lodged in the right bronchus.
On the 19th, this opinion seemed to be confirmed by a very simple
experiment, which Mr. B. had himself made in the interval. He had placed
himself in the prone position, with his sternum resting on a chair, and
his head and neck inclined downwards, and, having done so, immediately
had a distinct perception of a loose body slipping forward along the
trachea. A violent convulsive cough ensued. On resuming the erect
posture, he again had the sensation of a loose body moving in the
trachea, but in the opposite direction, that is, towards the chest.
On the 20th, I saw the patient again, with Dr. Thompson. I now suggested
that a further consultation should be held on the case; and,
accordingly, on the following day there was a meeting of Dr. Chambers,
Dr. Seth Thompson, Mr. Stanley, Mr. Aston Key, and myself. The chest was
again carefully examined by means of the stethoscope, but no difference
in the state of the respiration could be detected. The other indications
of the existence of a foreign body in the air passages, however, seemed
to be so strong, that no one entertained any doubt on the subject. At
this meeting it was agreed that the experiment, which Mr. B. had himself
made; should be repeated in a more complete manner. Accordingly, on the
25th of April, he was placed in the prone position, on a platform made
to be moveable on a hinge in the centre, so that on one end of it being
elevated, the other was equally depressed. The shoulders and body having
been fixed by means of a broad strap, the head was lowered until the
platform was brought to an angle of about 80 degrees with the horizon.
At first no cough ensued; but on the back, opposite the right bronchus,
having been struck with the hand, Mr. B. began to cough violently. The
half-sovereign, however, did not make its appearance. This process was
twice repeated, with no better result; and, on the last occasion, the
cough was so distressing, and the appearance of choking was so alarming,
that it became evident that it would be imprudent to proceed further
with this experiment, unless some precaution were used to render it more
safe.
On the 27th of April, in a consultation of Dr. Seth Thompson, Mr. Aston
Key, and myself, it was agreed that an artificial opening should he made
in the trachea, between the thyroid gland and the sternum. In proposing
this, we had a two-fold object; the one, that if the coin were lodged in
any part from which it might be safely extracted by the forceps, this
method might be had recourse to; and the other, that, if relief could be
obtained in this manner, the artificial opening might answer the purpose
of a safety-valve, and enable us to repeat the experiment of inverting
the body on the moveable platform, without the risk of causing
suffocation. The operation was immediately performed by myself, with the
assistance of Mr. Aston Key and Mr. Charles Hawkins; and on it being
completed, some attempts were made, both by Mr. Key and by myself, to
reach the coin with the forceps introduced through the opening. The
contact of the instrument with the internal surface of the trachea,
however, induced on any occasion the most violent convulsive coughing.
The coin was not seized, nor even felt; and our apprehensions of
producing some serious mischief were such that we did not deem it
prudent, at that time, to persevere in our endeavours to remove it.
On the 2nd of May, we again made some trials with the forceps, but
always with the same result. A violent convulsive action of the
diaphragm and abdominal muscles ensued, on each introduction of the
instrument; and the danger of groping in the bronchus, under such
circumstances, surrounded as it is by the most remarkable assemblage of
vital organs in the whole body, appeared to us to be so great, that we
did not think ourselves justified in proceeding further. We were the
more inclined to abandon the experiment with the forceps, as we had a
strong expectation that a recurrence to the first experiment, now that
the safety-valve was established, would prove successful.
On the 3rd of May, a consultation was held with Mr. Lawrence and Mr.
Stanley. They entirely concurred in the views of Mr. Aston Key and
myself, and it was agreed that nothing more should be attempted until
Mr. B. had sufficiently recovered from the effects of what had been
already done to admit of his being again inverted on the moveable
platform.
A probe, or director, was occasionally introduced into the wound of the
trachea, with a view to keep it in an open state; and, on the 13th of
May, the patient having been placed on the platform, and brought into
the same position as formerly, the back was struck with the hand; two or
three efforts to cough followed, and presently he felt the coin quit the
bronchus, striking almost immediately afterwards against the incisor
teeth of the upper jaw, and then dropping out of the mouth; a small
quantity of blood, drawn into the trachea from the granulations of the
external wound, being ejected at the same time. No spasm took place in
the muscles of the glottis, nor was there any of that inconvenience and
distress which had caused no small degree of alarm on the former
occasion.
It is unnecessary to describe the progress of the case afterwards. On
the 20th of May, Mr. B. had sufficiently recovered to be able to go for
change of air into the country, and when I saw him, about a fortnight
afterwards, the wound of the neck was nearly
healed.—_Medico-Chirurgical Transactions, vol. xxvi._
EXTRACTS.
ON THE EMPLOYMENT OF COCHINEAL IN THE
TREATMENT OF HOOPING COUGH.
Dr. Cajetan Wachtl, of Vienna, treated nine children, suffering from
hooping-cough, with cochineal, as recommended by certain English
physicians. The remedy was administered in all stages of the disease;
and its efficacy was so instantaneous and constant that, notwithstanding
the paucity of cases, Dr. Wachtl feels authorized to regard cochineal as
a specific in hooping-cough. The following is his manner of exhibiting
the remedy:—Take of cochineal, one scruple; sugar, one ounce.—Dissolve
in six ounces of warm water. The dose is three teaspoons-full in the
twenty-four hours.
The solution ought not to be kept longer than thirty-six or forty-eight
hours, because after that time it assumes a brown hue, and a sour taste,
which renders it unfit for use.—_Pharmaceutical Journal._—_London
Medical Gazette, January 26, 1844._
OPIUM IN HERNIA.
_To the Editor of the Medical Gazette._
Sir,—The following is a case showing the good effects of opium in
strangulated hernia.
I was sent for, at 10 P.M. on the 24th inst. to visit R. H. aged 45, a
stout, muscular man, suffering under strangulated scrotal hernia in the
right side. He had been trying for an hour to reduce it, having done so
frequently before, but now he informed me it was a great deal larger. He
was vomiting, and complained on the least pressure. In consequence of
the extreme tenderness, I did not persevere in the taxis, but decided on
putting him under the influence of opium. I gave him two grains every
fifteen minutes, until he had taken six grains, and to use hot
fomentations. Shortly after the first pill the vomiting ceased; and when
I visited him again at half-past 12 P.M. I found them preparing to come
and stop my visit, as he had got relief. I found him, as he said,
exceedingly comfortable: it was quite evident he was enjoying all the
luxury of an opium eater. Upon inquiry, he told me he had not touched
the swelling, but that it had gone away of its own accord.
I am, Sir,
Your obedient servant,
J. M. Walker, M. R. C. S. L.,
Newcastle-on-tyne, January 1, 1844.
_London Medical Gazette, January 12, 1844._
ANTIQUARIAN NOTICES OF LEPROSY AND
LEPER HOSPITALS IN SCOTLAND AND ENGLAND.
This is an extremely elaborate and erudite paper, to show the former
frequency and severity of this loathsome disease in these kingdoms.
According to the Anglo-Saxon lexicographies of Sommer, Lye, and
Bosworth, “leprosy” was heretofore known by the singular and striking
term, “seo mycle adl,” “the muckle or great evil” or disease. In the
year 1200, there were in the counties of Northumberland, Cumberland, and
Durham, a variety of hospitals, exclusively devoted to lepers. Three of
these contained so many as ninety-five lepers; namely, those of
Sherburne, near Durham, of Carlisle, and Bolton in Northumberland.
Bloomfield, in his history of Norfolk, states that there were eighteen
lazar-houses in Norfolk alone. In some of these the patients were amply
provided for.
Astruc, Bach, and our own historians, Fuller and Heron, supposed that
leprosy was introduced by those who returned from the Crusades, and
brought it from the east. But the author of the present paper remarks
that, even allowing that the disease is contagious, and that the
increased national intercourse of that period may have tended to
propagate it, there is ample evidence of its having existed in Europe,
and even as far west as England, before the Crusades. It lingered long
in Scotland after it had disappeared in England, and long in the
northern islands of the former kingdom, as in Shetland, after it had
left the mainland. In the Faroe islands (the land nearest the Shetland,
northward), and in Iceland, it either still exists or existed at a very
late period. In 1768, Peterson found 280 lepers in hospitals in Iceland.
Olafsen and Henderson described the disease as existing when they
visited the island in 1818. And the French expedition of 1836 brought
back coloured sketches of natives affected with tubercular leprosy,
which sketches are now in course of publication.—_Dr. Simpson, Prof. of
Midwifery in University of Edinburgh_—_Edinburgh Med. and Surg.
Journal, Oct. 1, 1841._
* * * * *
THE MONTREAL MEDICAL GAZETTE,
IS PUBLISHED MONTHLY.
SUBSCRIPTION, FIFTEEN SHILLINGS PER ANNUM.
Correspondents are requested to address the Editors, and in every
instance, prepay their communications.
PRINTED AND PUBLISHED BY LOVELL & GIBSON,
AT THEIR BOOK AND JOB PRINTING OFFICE,
ST. NICHOLAS STREET, IN REAR OF THE PEOPLE’S BANK.
TRANSCRIBER NOTES
Obvious printer errors have been corrected. Otherwise, inconsistencies
and possible errors in spelling and punctuation have been preserved,
with the following exception: “M‘” in names has been changed to “Mc”, as
in “McGill”.
[The end of _The Montreal Medical Gazette, Volume 1, Issue 3_ by Francis
Badgley/William Sutherland]